Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contact us Login 
  • Users Online:357
  • Home
  • Print this page
  • Email this page


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 10  |  Issue : 2  |  Page : 233-238

A study to evaluate the impact of COVID-19 on the mental health of medical students


1 Department of Physiology, Burdwan Medical College, Burdwan, West Bengal, India
2 Department of Physiology, Profulla Chandra Sen Government Medical College, Arambagh, West Bengal, India

Date of Submission23-May-2022
Date of Acceptance27-Jun-2022
Date of Web Publication23-Dec-2022

Correspondence Address:
Dr. Arunima Chaudhuri
Krishnasayar South, Borehat, Burdwan - 713 102, West Bengal
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/amhs.amhs_121_22

Rights and Permissions
  Abstract 


Background and Aim: The COVID-19 pandemic has imposed huge challenges on medical students and medical educators as they are the frontline workers in health-care management. The present study was conducted to evaluate and compare depression, anxiety, and stress levels and the Impact of Event Scale scores among different phases of undergraduate medical students. Materials and Methods: The present study was conducted online at Burdwan Medical College after taking institutional ethical clearance and informed consent from participants. The Depression, Anxiety, and Stress Scale-21 (DASS-21) scores and the Impact of Event Scale-Revised (IES-R) scores of all phases of MBBS students were evaluated during the first and second waves of the pandemic. Jamovi software was used for statistical analysis and ANOVA was used to compare different groups. Results: There was no significant difference in the DASS-21 scores among all five groups during the first wave, but significant differences were observed in IES-R scores. On post hoc analysis, significant differences were observed in the Intrusion, Avoidance, and Hyperarousal scores between 1st- and 5th-year, 2nd- and 5th-year, and 4th- and 5th-year students. During the second wave, significant differences in DASS-21 and IES-R parameters were observed between the different phases of MBBS students. There were significant positive correlations between IES-R scores and DASS-21 scores among 1st-year students and a significant negative correlation between IES-R scores and anxiety scores among 2nd-year students during the first evaluation. There were significant positive correlations between IES-R scores and DASS-21 scores among 1st-year students and a significant positive correlation between IES-R scores and stress scores among 5th-year students during the second evaluation. Conclusion: Senior batches of MBBS students were more mentally affected by the impact of the pandemic as evaluated by DASS-21 scores and IES-R scores. Levels of depression, stress, and anxiety were also increased during the second wave as compared to the first wave of the present pandemic.

Keywords: COVID-19 pandemic, Depression, Anxiety, and Stress Scale-21, Impact of Event Scale-Revised


How to cite this article:
Das S, Chaudhuri A, Ray B. A study to evaluate the impact of COVID-19 on the mental health of medical students. Arch Med Health Sci 2022;10:233-8

How to cite this URL:
Das S, Chaudhuri A, Ray B. A study to evaluate the impact of COVID-19 on the mental health of medical students. Arch Med Health Sci [serial online] 2022 [cited 2023 Jan 31];10:233-8. Available from: https://www.amhsjournal.org/text.asp?2022/10/2/233/364949




  Introduction Top


Medical education is inherently stressful. The huge curriculum, inadequate time to relax, and sudden exposure to unprecedented situations are some of the factors which increase psychological pressure. Junior doctors are suddenly exposed to huge patient loads in hospitals during their training, and this also causes a negative impact on their mental health. To serve the ailing population with adequate competency and care doctors of tomorrow need to be mentally and physically healthy, but this mental aspect of health care often remains neglected. The suicide rate is found to be higher among doctors in different studies across the world.[1],[2],[3] Abdulghani et al.[4] conducted a study to determine the prevalence of stress among medical students and to observe an association between the levels of stress and their academic performance. Abdel Rahman et al.[5] conducted a survey study among medical students, which shows that the prevalence of stress was 53% among Saudi students and medical students reported high levels of stress.

The 2019 coronavirus disease (COVID-19) with its significant outbreak of atypical pneumonia is now a global threat. The outbreak was first revealed in late December 2019 with a cluster of pneumonia cases of unknown etiology in Wuhan city of Hubei province. Since then, the corona cases had exponentially escalated within and beyond Wuhan, spreading to all 34 regions of China by January 30, 2020. On that day, the World Health Organization declared the COVID-19 outbreak a Public Health Emergency of International Concern.[6],[7] The COVID-19 pandemic had caused an enormous impact on medical education and health-care service in an unprecedented way. Medical education had to be continued online during the present pandemic.[8] Junior doctors being a part of the frontline health-care system were also under huge stress with the occupational burden. Medical students have to deal with the challenges of the rigorous academic curriculum in the new normal COVID-19 era and cope with emotionally difficult experiences. Unable to cope with stress effectively leads negative impact on academic and professional performances and increases psychological distress.[1],[2],[3],[4],[8]

The present study was conducted to assess the mental health status of medical students and intern doctors by the Depression, Anxiety, and Stress Scale-21 (DASS-21),[9] and the psychological impact of COVID-19 was measured using the Impact of Event Scale-Revised (IES-R).[6]


  Materials and Methods Top


This observational longitudinal study was conducted in a time span of 1 year after taking institutional ethical clearance (Memo No: BMC/IEC/20 dated January 8, 2021, and Memo No: BMC/IEC/147 dated November 23, 2020) and written informed consent of the participants.

Research design

This was an observational longitudinal study.

Study area

This study was conducted at Burdwan Medical College and Hospital.

Inclusion criteria

All students of the different MBBS batches in the age group of 18–25 years who were willing to participate in the study were included in the study.

Exclusion criteria

Medical students under psychiatric treatment with severe mental disorders were excluded from the study.

Tools for assessments

Depression, Anxiety, and Stress Scale-21

Mental health status was measured using the DASS-21. It is a valid screening instrument with a self-reported 21-item system. The DASS-21 stress subscale score is divided into depression subscale, anxiety subscale, and stress subscale. The cutoff score >9, >7, and >14 represents a positive screening of depression, anxiety, and stress, respectively.

The Impact of Event Scale-Revised

The IES-R questionnaire is a self-reported scale and has 22 questions. Five of which were added to the original Horowitz (IES R) to better capture the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders criteria for posttraumatic stress disorder.

Sample size

The sample size was calculated using an online sample size calculator at www.calcular.net. (confidence level: 95%; margin of error: 5%; population proportion: 50%).

There was the following number of students in different batches in Burdwan Medical College:

  • 1st-year MBBS students: 200
  • 2nd-year MBBS students: 200
  • 3rd-year MBBS students: 150
  • 4th-year MBBS students: 150
  • 5th-year interns: 150.


Calculated sample size:

  • 1st-year MBBS students: 132
  • 2nd-year MBBS students: 132
  • 3rd-year MBBS students: 109
  • 4th-year MBBS students: 109
  • 5th-year interns: 109.


The total study population was subdivided into five groups according to different phases of MBBS. The groups were gender matched (Chi-square: 6.58; P = 0.16). From the whole batches of different phases of MBBS students, the participants were selected using an online randomizer. Five hundred and ninety-one students participated in the study. One hundred and thirty-two students of the first (86 males, 46 females) and second MBBS (80 males and 52 females) batches participated in the study. One hundred and nine students in the third (62 males, 47 females), fourth (57 males, 52 females), and fifth (56 males, 53 females) years were included in the study. The survey was conducted carried using Google Forms and strict confidentiality of the data was maintained. Consent was also taken in the first section of Google Forms. The first assessment was done between December 2020 and February 2021 and the second assessment between June 2021 and August 2021. The reassessment was done after 6 months. In the first assessment, it was observed that many students had high levels of depression, anxiety, and stress. The students were provided feedback regarding their mental health status, and a second survey was planned to be conducted 6 months later to see changes in mental health status.

Statistical analysis

Jamovi software was used for the analysis of data. ANOVA with post hoc analysis was used to compare the different groups, and the correlation coefficient was calculated to study the correlation between DASS-21 scores and IES-R scores. P < 0.05 was considered statistically significant.


  Results Top


This study was conducted during the COVID-19 pandemic to assess DASS-21 scores and IES-R scores and their correlation among all phases of MBBS students. Five hundred and ninety-one students of a government medical college in West Bengal participated in the study. Evaluation of DASS-21 scores and IES-R scores was done twice: once during the first wave and the second during the second wave of the pandemic. There was no significant difference in the DASS-21 scores among all five groups during the first wave, but significant differences were observed in IES-R scores [Table 1]. On post hoc analysis, significant differences were observed in the Intrusion, Avoidance, and Hyperarousal scores between 1st- and 5th-year, 2nd- and 5th-year, and 4th- and 5th-year students [Table 2]. During the second wave, significant differences in DASS 21 and IES R parameters were observed between the different phases of MBBS students [Table 3]. Post hoc analysis showed significant differences in DASS-21 scores between 1st- and 2nd-year, 1st- and 3rd-year, 1st- and 5th-year, 2nd- and 5th-year, 3rd- and 5th-year, and 4th- and 5th-year students with increasing scores observed among senior students [Table 4]. On the evaluation of IES-R scores (post hoc), significant differences were observed between 1st- and 5th-year, 2nd- and 4th-year, 2nd- and 5th-year, and 3rd- and 5th-year students with higher scores among senior years [Table 4]. During the first evaluation, severe and extremely severe depression was seen in 82 (13.87%) students, severe and extremely severe stress was seen in 45 students (7.6%), and severe and extremely severe anxiety was seen in 99 (16.75%) students. During the second evaluation, severe and extremely severe depression was seen in 184 (31.13%) students, severe and extremely severe stress was seen in 232 (39.26%) students, and severe and extremely severe anxiety was seen in 244 (41.2%) students. [Table 5] shows that there were significant positive correlations between IES-R scores and DASS-21 scores among 1st-year students and a significant negative correlation between IES-R scores and anxiety scores among 2nd-year students during the first evaluation. [Table 6] shows that there were significant positive correlations between IES-R scores and DASS-21 scores among 1st-year students and a significant positive correlation between IES-R scores and stress scores among 5th-year students during the second evaluation.
Table 1: Comparison of different parameters (Depression, Anxiety, and Stress Scale-21 and Impact of Event Scale-Revised) of the five MBBS batches on initial assessment (ANOVA)

Click here to view
Table 2: Multiple comparisons (post hoc) of different parameters (Depression, Anxiety, and Stress Scale-21 and Impact of Event Scale-Revised) of the five MBBS batches on initial assessment

Click here to view
Table 3: Comparison of different parameters (Depression, Anxiety, and Stress Scale-21 and Impact of Event Scale-Revised) of the five MBBS batches on assessment after 6 months (ANOVA)

Click here to view
Table 4: Multiple comparisons (post hoc) of different parameters (Depression, Anxiety, and Stress Scale-21 and Impact of Event Scale-Revised) of the five MBBS batches on the second assessment

Click here to view
Table 5: Correlation with Impact of Event Scale-Revised with Depression, Anxiety, and Stress Scale-21 scores on initial assessment among five batches of MBBS students

Click here to view
Table 6: Correlation with Impact of Event Scale-Revised with Depression, Anxiety, and Stress Scale-21 scores on assessment after 6th month among five batches of MBBS students

Click here to view



  Discussion Top


The present study was conducted to evaluate DASS-21 scores and IES-R scores of different phases of MBBS students and observe their correlations during the first and second waves of the COVID-19 pandemic. The 1st- and 2nd-year students were considered junior batches in the present study. Five hundred and ninety-one students of a government medical college in West Bengal participated in the study. There was no significant difference in the DASS-21 scores among all five groups during the first wave, but significant differences were observed in IES-R scores. During the second wave, significant differences in DASS-21 and IES-R parameters were observed between the different phases of MBBS students. During the first evaluation, severe and extremely severe depression was seen in 82 students, severe and extremely severe stress was seen in 45 students, and severe and extremely severe anxiety was seen in 99 students. During the second evaluation, severe and extremely severe depression was seen in 184 students, severe and extremely severe stress was seen in 232 students, and severe and extremely severe anxiety was seen in 244 students.

In a study by Chakladar et al.[10] during the present pandemic, 300 students from 5 US medical schools also reported higher levels of depression, anxiety, and uncertainty with regard to their futures as doctors. In the present study conducted at Burdwan Medical College, similar findings were observed.

A cross-sectional survey was conducted online by Harries et al.[11] in the United States among 740 medical students. Survey questions were aimed to evaluate students' perceptions of anxiety and burnout. Students in the study reported that the pandemic had moderate effects on their stress and anxiety levels, with 84.1% of respondents having a feeling of being anxious. Our students had high levels of anxiety during the second wave of the pandemic, and this was increased among senior students.

The study by Seetan et al.[12] was conducted at six Jordanian medical schools on 553 medical students using an online survey. Assessment of mental well-being status was done by using Kessler's Psychological Stress Scale (K10). The study indicated that half of the students suffered from severe mental disorders and physical fitness was affected due to lack of exercise.

An online analytical cross-sectional survey was conducted in Indonesia on 1027 medical students by Natalia and Syakurah.[13] This study used the Fear of COVID-19 Scale and the DASS-21. 44.6% were stressed and 47.8% had anxiety and were suffering from 18.6% depression. Our study was a longitudinal one.

A longitudinal study was conducted by Saraswathi et al.[14] in Chennai on 217 undergraduate medical students. Depression, anxiety, and stress levels were recorded using DASS-21 Items before and during the COVID-19 outbreak in India. During the follow-up survey, the Pittsburgh Sleep Quality Index was also used to assess sleep quality, and a self-administered questionnaire to assess the impact of COVID-19-related stressors was used. The average scores for depression, anxiety, and stress during the baseline survey were 7.55 ± 7.86, 4.6 ± 6.19, and 7.31 ± 7.34, respectively. During the follow up survey depression, anxiety and stress scores were as follows: 8.16 ± 8.9; 6.11 ± 7.13; 9.31 ± 8.18 There was a significant increase in both the prevalence and levels of anxiety and stress but no change in depression.

A questionnaire-based study of medical students from across India was conducted online using Google Forms. The General Health Questionnaire-28 was used and 1000 responses were collected for a period between May 12 and June 11 in the year 2020. It was observed that mental health issues are quite common among medical students, and early identification and counseling were recommended.[15] This is one of the causes why we have assessed our students twice, but although we had increased awareness among students regarding their mental health issues, we did not observe any positive impact on the second assessment.

A study was conducted to determine the prevalence of stress among medical students and its association with sleep during the present pandemic. Perceived stress and sleep quality were assessed among 446 participants. First-year and final-year medical students perceived more stress as compared to other years. 7.6% reported poor sleep quality.[16] We also observed higher levels of stress among final-year students but not among 1st-year students.

Strengths and limitations

This longitudinal study was conducted during the present pandemic to assess the mental health status of medical students, and students of all professional batches were assessed. However, long-term follow-up was not done. We only made the 3rd- to 5th-year students aware of their mental health status and could only advise them to seek help when required, but we did not provide them with any intervention. The competency-based medical education has been implemented in 2019, and stress management is an integral part of the new curriculum. Hence, we regularly teach new students' stress-management strategies. This may be a cause of lesser DASS-21 scores and IES-R scores among junior batches as compared to senior batches. This study was conducted online, so there may have been a difference in the clinical examination of the participants.


  Conclusion Top


Senior batches of MBBS students were more mentally affected by the impact of the pandemic as evaluated by DASS-21 scores and IES-R scores. Levels of depression, stress, and anxiety were also increased during the second wave as compared to the first wave of the present pandemic.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Vagni M, Maiorano T, Giostra V, Pajardi D. Hardiness, stress and secondary trauma in Italian healthcare and emergency workers during the COVID-19 pandemic. Sustainability 2020;12:5592.  Back to cited text no. 1
    
2.
Rogers ME, Creed PA, Searle J. Emotional labour, training stress, burnout, and depressive symptoms in junior doctors. J Vocat Educ Train 2014;66:232-48.  Back to cited text no. 2
    
3.
Schernhammer ES, Colditz GA. Suicide rates among physicians: A quantitative and gender assessment (meta-analysis). Am J Psychiatry 2004;161:2295-302.  Back to cited text no. 3
    
4.
Abdulghani HM, AlKanhal AA, Mahmoud ES, Ponnamperuma GG, Alfaris EA. Stress and its effects on medical students: A cross-sectional study at a college of medicine in Saudi Arabia. J Health Popul Nutr 2011;29:516-22.  Back to cited text no. 4
    
5.
Abdel Rahman AG, Al Hashim BN, Al Hiji NK, Al-Abbad Z. Stress among medical Saudi students at College of Medicine, King Faisal University. J Prev Med Hyg 2013;54:195-9.  Back to cited text no. 5
    
6.
Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, et al. Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. Int J Environ Res Public Health 2020;17:E1729.  Back to cited text no. 6
    
7.
Shah S, Diwan S, Kohan L, Rosenblum D, Gharibo C, Soin A, et al. The technological impact of COVID-19 on the future of education and health care delivery. Pain Physician 2020;23:S367-80.  Back to cited text no. 7
    
8.
Barzilay R, Moore TM, Greenberg DM, DiDomenico GE, Brown LA, White LK, et al. Resilience, COVID-19-related stress, anxiety and depression during the pandemic in a large population enriched for healthcare providers. Transl Psychiatry 2020;10:291.  Back to cited text no. 8
    
9.
Lovibond SH, Lovibond PF. Manual for the Depression Anxiety and Stress Scales. 2nd ed. Sydney: Psychology Foundation; 1995.  Back to cited text no. 9
    
10.
Chakladar J, Diomino A, Li WT, Tasi JC, Krishnan AR, Zou AE, et al. Medical student's perception of the COVID-19 pandemic effect on their education and well-being: A cross-sectional survey in the United States. BMC Med Educ 2022;22:1-10.  Back to cited text no. 10
    
11.
Harries AJ, Lee C, Jones L, Rodriguez RM, Davis JA, Boysen-Osborn M, et al. Effects of the COVID-19 pandemic on medical students: A multicenter quantitative study. BMC Med Educ 2021;21:14.  Back to cited text no. 11
    
12.
Seetan K, Al-Zubi M, Rubbai Y, Athamneh M, Khamees A, Radaideh T. Impact of COVID-19 on medical students' mental wellbeing in Jordan. PLoS One 2021;16:e0253295.  Back to cited text no. 12
    
13.
Natalia D, Syakurah RA. Mental health state in medical students during COVID-19 pandemic. J Educ Health Promot 2021;10:208.  Back to cited text no. 13
    
14.
Saraswathi I, Saikarthik J, Senthil Kumar K, Madhan Srinivasan K, Ardhanaari M, Gunapriya R. Impact of COVID-19 outbreak on the mental health status of undergraduate medical students in a COVID-19 treating medical college: A prospective longitudinal study. PeerJ 2020;8:e10164.  Back to cited text no. 14
    
15.
Mangalesh S, Dudani S, Dave ND. Assessment of mental health in Indian medical students during the coronavirus disease-2019 pandemic. Indian J Soc Psychiatry 2021;37:105-10.  Back to cited text no. 15
  [Full text]  
16.
Praveena Daya A, Anithasri A, Prema Priya G, Ilamathi KR, Karthikeyan G. Perceived stress among medical students during COVID-19 pandemic and its impact on sleep and studies – A cross-sectional study in South India. Special Issue COVID-19 Other Commun Dis 2022:143-9.  Back to cited text no. 16
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Materials and Me...
Results
Discussion
Conclusion
References
Article Tables

 Article Access Statistics
    Viewed190    
    Printed8    
    Emailed0    
    PDF Downloaded23    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]